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Biomedical subjects

R McKenzie

Publications and source records attributed to R McKenzie.

106 records · Page 6Linked to original sources
PubMed1971

Laparoscopy.

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Abdomen↗
PubMedDate not supplied

Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial.

CONTEXT: Chronic fatigue syndrome (CFS) is associated with a dysregulated hypothalamic-pituitary adrenal axis and hypocortisolemia. OBJECTIVE: To evaluate the efficacy and safety of low-dose oral hydrocortisone as a treatment for CFS. DESIGN: A randomized, placebo-controlled, double-blind therapeutic trial, conducted between 1992 and 1996. SETTING: A single-center study in a tertiary care research institution. PATIENTS: A total of 56 women and 14 men aged 18 to 55 years who met the 1988 Centers for Disease Control and Prevention case criteria for CFS and who withheld concomitant treatment with other medications. INTERVENTION: Oral hydrocortisone, 13 mg/m2 of body surface area every morning and 3 mg/m2 every afternoon, or placebo, for approximately 12 weeks. MAIN OUTCOME MEASURES: A global Wellness scale and other self-rating instruments were completed repeatedly before and during treatment. Resting and cosyntropin-stimulated cortisol levels were obtained before and at the end of treatment. Patients recorded adverse effects on a checklist. RESULTS: The number of patients showing improvement on the Wellness scale was 19 (54.3%) of 35 placebo recipients vs 20 (66.7%) of 30 hydrocortisone recipients (P =.31). Hydrocortisone recipients had a greater improvement in mean Wellness score (6.3 vs 1.7 points; P=.06), a greater percentage (53% vs 29%; P=.04) recording an improvement of 5 or more points in Wellness score, and a higher average improvement in Wellness score on more days than did placebo recipients (P<.001). Statistical evidence of improvement was not seen with other self-rating scales. Although adverse symptoms reported by patients taking hydrocortisone were mild, suppression of adrenal glucocorticoid responsiveness was documented in 12 patients who received it vs none in the placebo group (P<.001). CONCLUSIONS: Although hydrocortisone treatment was associated with some improvement in symptoms of CFS, the degree of adrenal suppression precludes its practical use for CFS.

Adult↗
PubMedDate not supplied

A randomized, double-blind pilot study examining the use of intravenous ondansetron in the prevention of postoperative nausea and vomiting in female inpatients.

STUDY OBJECTIVE: To compare the efficacy and safety profiles of intravenous (IV) ondansetron (two 8 mg doses 8 hours apart) and a placebo when used in the prevention of postoperative nausea and emesis (vomiting or retching). DESIGN: Randomized, double-blind, placebo-controlled, parallel, multicenter pilot study. SETTING: Four university hospitals in the United States. PATIENTS: Two hundred seven women scheduled to undergo inpatient surgical procedures during general anesthesia. INTERVENTIONS: Patients were randomized to receive, in a double-blind fashion, either two 8 mg doses of IV ondansetron or a placebo. The first study drug dose was administered before induction of anesthesia; the second dose was given 8 hours later. Each study drug dose was admixed with normal saline to 20 ml and administered IV over 2 to 5 minutes. Vital signs were monitored immediately before and 1 minute after completion of the study drug infusion. MEASUREMENTS AND MAIN RESULTS: For the 24-hour period following operation, 60% of the patients who received ondansetron and 26% of the patients who received the placebo were emesis-free (p < 0.001). Subanalyses based on patients' previous history of general anesthesia indicated that ondansetron was superior to the placebo in preventing emesis regardless of history [66% vs. 33% in patients who had never had general anesthesia or had had no nausea or emesis following previous anesthesia (p = 0.001) and 50% vs. 17% in patients who had nausea or emesis following previous anesthesia (p = 0.005)]. Ondansetron also was superior to the placebo for the prevention of nausea over the 24-hour study period regardless of anesthesia history. Ondansetron was generally well tolerated. The adverse event, vital sign, and clinical laboratory test profiles were similar to those for the placebo. No patient who received ondansetron had untoward changes in central nervous system function, including sedation. CONCLUSIONS: Prophylactic IV ondansetron appears to be safe and causes a significant reduction in the frequency and severity of postoperative nausea and emesis.

Adolescent↗
PubMedDate not supplied

Pneumatosis intestinalis associated with needle catheter jejunostomy tubes: CT findings and implications.

The CT findings of pneumatosis intestinalis (PI) associated with needle catheter jejunostomy tubes (NCT) are described in two patients. Each case had cyst-like intramural gas collections associated with the NCT. Neither case had focal bowel wall thickening or portal or mesenteric free air, and there was no evidence of intestinal necrosis. Our findings suggest that cyst-like intramural gas collections associated with NCT represent a benign form of PI.

Catheters, Indwelling↗
PubMedDate not supplied

Anesthesia for jejunoileal shunt: review of 88 cases.

Experience with 88 obese pateints undergoing jejunoileal shunt is reviewed, with emphasis on preoperative preparation and assessment, conduct of anesthesia, postoperative care, and anesthesia-related complications. There was no intraoperative mortality, and postoperative morbidity was minimal. The operation can be viewed as a short-term answer to the malignancy of massive obesity, since physiologic abnormalities are reversible; however, only hospitals that can provide full surgical, medical, endocrinologic, and anesthesia services, backed by modern ancillary investigative ability, should perform this operation.

Adult↗